Both regulated and unregulated workers and professionals undertake the delivery of healthcare services within Australia. Unregulated health workers and professionals are those not registrable or registered with a professional regulatory authority. That is, they are not required to have a practising licence, conferred by a regulatory authority, in order to work within the healthcare system. Examples of unregulated health workers or professionals include personal care attendants, dieticians and social workers. Regulated health professionals, such as nurses, pharmacists and medical practitioners must, however, possess a licence or practising certificate conferred by a professional regulatory authority in order to work in their chosen professions. The status of registration thereby restricts those who may practice in an identified profession to only those who hold a practising licence or certificate. Registration also confers on those professionals the legal authority to use an identified title (such as doctor, medical practitioner, or pharmacist) and undertake certain tasks; for example, prescribing narcotics or carrying out a specific procedure such as surgery. The objectives of registration and regulation of medical practitioners in Australia is to protect the public and maintain professional standards of practice. These objectives are met through the registration and regulation processes which require that each medical practitioner possesses the requisite educational qualifications, is fit to practice in their chosen profession and maintain a standard of conduct which is consistent with that expected by their peers and the public.

At the time of writing, the registration and regulation of medical practitioners is governed by the relevant state and territory Acts which establish medical boards in each of the individual jurisdictions. There are currently in excess of eighty health practitioner registration boards across Australia. ¹ By 1 July 2010, however, a national registration and accreditation scheme will be in place which aims to standardise the regulation and disciplinary procedures across all the regulated health professionals. This chapter will provide an overview of the structures and broad principles relevant to the registration and regulation of those health professionals, including medical practitioners, who will be included under the national scheme. The chapter will also outline the professional disciplinary issues and procedures, and the codes of ethics and conduct, relevant to the regulation of medical practitioners.

In 2005 the Commonwealth government requested that the Productivity Commission conduct a study into:

In 2006 the Council of Australian Governments (COAG) supported the recommendations as contained in the Productivity Commission Research Report titled Australia’s Health Workforce, and agreed to establish both a single national registration board and a single national accreditation board for the registration, eduction and training of health professionals. In 2008 COAG, under an intergovernmental agreement, agreed to establish a single national scheme ‘to create nationally consistent, rigorous registration and accreditation arrangements and improve public protection’. ³

The objectives of the scheme were to: ⁵

Queensland was the state chosen to initially enact the substantive legislation giving effect to the national scheme. The national legislation was enacted in Queensland in two stages. The first stage, covering the provisions of the COAG Agreement, was introduced into the Queensland Parliament in October 2008⁶ and the second stage in August 2009. The second stage included details for the arrangements required for registration, accreditation, complaints and enforcement, privacy and information sharing. ⁷ Extensive consultation, involving the professions and the public, was conducted as part of the process. ⁸ The other states and territories have followed the Queensland lead using their ‘best endeavours’ to repeal their existing regulatory legislation in relation to the health professionals included under the new scheme.

The legislative framework was introduced in such a way, and at a pace, so as to facilitate the development of entities and administrative arrangements necessary to implement the new national scheme. The following is an overview of the stages and legislation establishing the National Law: ⁹

Table 11.1 provides an overview of the implementation of the national scheme across the jurisdictions.

From 1 July 2010 the national registration and accreditation scheme covers the ten health professions to be initially included in the national scheme: chiropractors; dental (including dentists, dental hygienists, dental prosthetists and dental therapists); medical practitioners; nurses and midwives; optometrists; osteopaths; pharmacists; physiotherapists; podiatrists; and psychologists. From 1 July 2012 the scheme will be expanded to include Aboriginal and Torres Strait Islander health practitioners, Chinese medicine practitioners, and medical radiation practitioners. ¹²

In November 2008 the Health Practitioner Regulation (Administrative Arrangements) National Law Act (Qld) was enacted to establish the structure of the national registration and accreditation scheme and empower the bodies identified under the Act to develop and implement the scheme. The Act established the Ministerial Council, Australian Health Workforce Advisory Council, National Agency (the affairs of which are to be conducted by the Agency Management Committee) and the National Boards for each of the health professions covered by the scheme. ¹³ In relation to medical practitioners, the Medical Board of Australia was established under the Act. There will also be a local presence for each of the professional disciplines in each state and territory. Section 3 of the Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008 (Qld) (‘the Act’) states the object of the legislation:

The Ministerial Council, comprising the Ministers of government in the participating jurisdictions of the Commonwealth with portfolios responsibile for health, must take into account concerns and advice from the Australian Health Workforce Advisory Council (Advisory Council). In anticipation of the commencement of the national registration and accreditation scheme, the Ministerial Council may also approve ‘health profession standards’¹⁵ for any health profession provided it has been approved by the National Board established for that particular discipline of health professionals. In addition, the Ministerial Council is empowered to request that a particular National Board review a health profession standard, and approve or revoke amendments to an existing health profession standard. That is, the Ministerial Council may request the Medical Board of Australia to review, approve, revoke or amend professional standards for medical practitioners in Australia.

The Advisory Council is established under Part 3 of the Act as an independent body which provides advice to the Ministerial Council on: ¹⁶

Part 4 of the Act provides for the Australian Health Practitioners Regulation Agency and, under s 18, the National Agency. The principle functions of the National Agency are set out in section 20(1) as follows:

The National Agency is required to establish a national office and at least one office in each participating state and territory.

The Agency Management Committee is established to conduct the affairs of the National Agency and is subject to the direction of the Ministerial Council. It is the role of the Agency Management Committee to determine the policies of the National Agency and ensure the National Agency performs its functions ‘in a proper, effective and efficient way’. ¹⁷

The National Agency is required to establish National Boards¹⁸ for each discipline of health professions covered by the scheme. Under the Health Practitioner Regulation National Law Act (2009) the functions of the National Boards are to include:

On 8 May 2009 the Australian Workforce Ministerial Council issued a communiqué on the design of the national registration and accreditation scheme. In this communiqué the Australian Workforce Ministerial Council agreed that the function of accreditation was to be independent of government with accreditation standards developed by independent accrediting bodies or accreditation committees of the professional boards. The final decision as to whether ‘the accredited standards, courses and training programs are approved for the purposes of registration is the responsibility of the National Board’. ¹⁹ It is noted, however, that the Ministerial Council has retained the power to act where changes to accreditation standards, such as clinical placement hours or workplace or work practices, would ‘have a significantly negative effect’. ²⁰ The national accreditation standards that currently exist are to continue until replaced by new standards. Bodies such as the Australian Medical Council and the Australian Pharmacy Council will continue in their current roles. In addition, the communiqué outlined the following: